Total of 18 individuals participated in the study. The mean age of the participants was 38 years with standard deviation (SD) of 11.88). Two-third of the participants (n = 12, 66.6%) were females. Similarly, 12 (66.6%) participants were pre-diabetic. Out of remaining 6 (33.3%) participants, one was with anterior cruciate ligament injury of knee (at 3 months of surgical repair), two were with low back ache (one at 18 days and another at 1.5 months), one was with stroke (at 1.5 months who was able to do activities independently), one was with Bell’s palsy (at 15 days of disease onset) and one was with cardiac disease (at 3 months after open heart surgery). As shown in Table 1, the mean score for 6-item adherence behavior and 10-item reasons for adherence/non-adherence ranged from 2.17 to 2.83 and 0.83 to 3.39 respectively. The score of item 9 of 10-item reasons for adherence/non-adherence was minimum (mean: 0.83, SD: 1.38).
Table 1
Demographic and clinical characteristic of the participants (N = 18)
Variables | Mean (SD) | N (%) |
Age (year) | 38 (11.88) | |
Gender | | |
Male | - | 6 (33.3) |
Female | - | 12 (66.6) |
Participants’ conditions | | |
Pre-diabetic | - | 12 (66.6) |
Others (ligament injury, low backache, stroke, Bell’s palsy and cardiac disease) | - | 6 (33.3) |
Exercise Adherence Rating Scale | 1. I do my exercises as often as recommended | 2.83 (1.30) | - |
2. I forget to do my exercises | 2.50 (1.58) | - |
3. I do less exercise than recommended by my health care professional | 2.17(1.38) | - |
4. I fit my exercises in to my regular routine | 2.61(1.38) | - |
5. I don’t get around to doing my exercises | 2.78 (1.59) | - |
6. I do most, or all, of my exercises | 2.56 (1.29) | - |
Reasons for adherence/ non-adherence | 1. I don’t have time to do my exercises | 3.00 (1.28) | - |
2. Other commitments prevent me from doing my exercises | 2.83 (1.43) | - |
3. I don’t do my exercises when I am tired | 1.56 (1.20) | - |
4. I feel confident about doing my exercises | 2.72 (1.23) | - |
5. My family and friends encourage me to do my exercises | 2.39 (1.29) | - |
6. I do my exercises to improve my health | 2.61 (1.38) | - |
7. I do my exercises because I enjoy them | 2.39 (1.50) | - |
8. I adjust the way I do my exercises to suit myself | 1.67 (1.57) | - |
9. I stop exercising when my pain is worse | 0.83 (1.38) | - |
10. I’m not sure how to do my exercises | 3.39 (1.29) | - |
Note: SD: Standard Deviation, N: Number |
Test of reliability
As shown in Table 2, the Cronbach’s alpha was 0.94 and 0.74 for adherence behavior and reasons for adherence/non-adherence scale respectively. The Cronbach’s alpha if item deleted ranged from 0.91 to 0.93 for 6-item adherence behavior. Removal of any item would result lower Cronbach’s alpha, and therefore each item has to be retained.
Table 2
Internal consistency of N-EARS (N = 18)
Scale (Adherence behavior) | Items | Cronbach’s Alpha | Corrected item-total correlation | Cronbach’s Alpha if item deleted |
Exercise Adherence Rating Scale | 1. I do my exercises as often as recommended | 0.94 | 0.79 | 0.92 |
2. I forget to do my exercises | 0.71 | 0.93 |
3. I do less exercise than recommended by my health care professional | 0.71 | 0.93 |
4. I fit my exercises in to my regular routine | 0.87 | 0.91 |
5. I don’t get around to doing my exercises | 0.88 | 0.91 |
6. I do most, or all, of my exercises | 0.88 | 0.91 |
Note: N-EARS: Nepali-Exercise Adherence Rating Scale, N: Number |
Test of validity: Construct validity was explored using an EFA. The KMO value for 6-items adherence behavior was 0.73, exceeding the recommended minimum value of 0.60 which verified sampling adequacy for the analysis. Bartlett’s test for sphericity indicated that correlations between items were sufficiently large (Chi square: 110.19, p < 0.001) for factor analysis. Thus, the criteria for sampling adequacy and sphericity for 6-items adherence behavior scale was achieved. As depicted in Table 3, the EFA of 6-items adherence behavior revealed the presence of one factor with an Eigen value exceeding one. The scree-plot suggested for extraction of only one factor with strong loading (75.84%). Since KMO value of 10-items of reasons for adherence/non-adherence was < 0.60, it was not suitable for EFA.
Table 3
Outcome of exploratory factor analysis of 6-items of N-EARS (N = 18)
Items | Component 1 | Total loading |
1. I do my exercises as often as recommended | 0.86 | 75.84% |
2. I forget to do my exercises | 0.78 |
3. I do less exercise than recommended by my health care professional | 0.79 |
4. I fit my exercises in to my regular routine | 0.93 |
5. I don’t get around to doing my exercises | 0.92 |
6. I do most, or all, of my exercises | 0.93 |
Note: N-EARS: Nepali-Exercise Adherence Rating Scale, N: Number |
The ROC curve, as shown in Fig. 2, demonstrated that Area Under the Curve (AUC) was 0.91 with 95% confidence interval 0.77 to 1.00 at p = 0.004. The cutoff score was found 17.5 with 89% sensitivity and 78% specificity.
Correlation: As a means of validating 6-item adherence behavior, the correlation analysis was done between 6-item adherence behavior with 10-item reasons for adherence/non-adherence scale, which demonstrated significant correlation (Pearson’s Coefficient, PC: 0.83, p < 0.001). The 6-items adherence scale demonstrated significant correlation with item 1 (PC = 0.69, p = 0.002), item 2 (PC = 0.55, p = 0.02), item 4 (PC = 0.76, p < 0.001), item 6 (PC = 0.84, p < 0.001), item 7 (PC = 0.70, p = 0.001) and with item 10 (PC = 0.75, p < 0.001). There was no significant correlation with items 3, 5, 8 and 9 (p > 0.05).